Front Lines
PIVOTED TO FACE COVID-19.
The fight against covid-19 is a global one, impacting health care workers at every level around the world. We spoke with alumni who are on the front lines in cities across the country about their experiences.
Madison Hunt, MD ’18 and Noah Archibald-Seiffer, MD ’18 were on the front lines in New York City, where one of the earliest and likely worst outbreaks occurred. The engaged couple are now third-year residents, Hunt in emergency medicine and Archibald-Seiffer in anesthesiology, at NYU Langone and Bellevue Hospital, the flagship public hospital and designated infectious disease center for the city.
While working the night shift in early March, Hunt noticed something out of the ordinary. “As a second-year resident, we’re really expected to carry most of the workload, to kind of own the ER, especially overnight.” A patient came in with respiratory issues. Hunt pulled up an X-ray and saw an image of lungs filled with opaque shadows that looked like ground glass—the hallmark of COVID-19. She then intubated three more patients that evening. “The attending physician and I just looked at each other and said, ‘It’s here.’”
Archibald-Seiffer and his colleagues first began to see the disease appearing in their elective patients. “We were having issues with older patients who had come in for other types of surgeries. We were having a much harder time getting them off of ventilators.”
Within a month, the hospitals were overrun. “I think at the height, of it, we had like 175 patients with COVID come through. During that time, I did perhaps five or six intubations a shift, which for a junior resident is unheard of.”
Everyone on staff seemed to divert to COVID care. “A lot of my training as an anesthesiologist is to manage the very sick while on respirators,” Archibald-Seiffer said. “The volume of cases we saw was far greater than anything I had trained for.”
“We know a lot more now than we did those first months,” Hunt said. “At the time, our protocols were to intubate quickly, for fear of patients going into acute hypoxic respiratory failure. Now we know that techniques like proning (lying on abdomen) are more effective. But we were struggling with a disease that two months before we didn’t know existed.”
And the caregivers were not immune. At one point, Archibald-Seiffer estimated that nearly one-third of his department was out sick with COVID or what was assumed to be COVID—before he contracted it.
“I’m lucky because I survived COVID,” he said. “But I can honestly say it was unlike any illness I’ve ever had. It was very rough.” Reflecting on his own case, Archibald-Seiffer worries more about his patients. “Hindsight is 20/20, but you worry about the things you did that were meant to help, but might have passed on the virus.”
Hunt also said the experience gave them a first-hand view of the disparities in health care. “NYU Langone is a private hospital and Bellevue is public, and the differences are stark. We truly do have two different and unequal health systems in this country. Two different types of care for the privileged and minorities,” Hunt said. “At Bellevue, I’ve seen patients who scraped and saved their whole lives to come to here, and they have to wait for basic, life-saving health care in ways others don’t.”
As cases abated in New York, the couple watched with concern as the disease spread to other cities and states. “We hoped that people would learn from what happened here. We didn’t want to see them make the same mistakes. But as the fall progresses, it seems like we’re headed down the same path.”
The couple was to be married in September, but delayed, and are now looking to 2021. “This is not how we wanted to start our lives,” Hunt said. “I know that this experience is making us better doctors. I hope what we learn will also make us a
stronger couple.”
On January 20, the first known case of COVID-19 in the US was reported in Snohomish County, Washington, just north of Seattle. Shortly after, a cluster of cases broke out in Life Care, a nursing home in the city of Kirkland. Just eight miles to the south stands Overlake Medical Center in Bellevue, one of six major health care centers in the area, where Cory Heidelberger serves as a physician in the ER.
“We were at the epicenter of the first significant outbreak of COVID-19 in the country,” Heidelberger said. “Patients from the nursing home first started going to their closest hospital, Evergreen. But then they were getting overwhelmed, so Evergreen began sending patients to other facilities, including ours. At first, everyone thought it was the flu.” They soon realized it wasn’t. Eventually, nearly 200 cases became linked to Life Care, and the disease killed a quarter of the nursing home’s residents.
Over the course of March, Heidelberger and fellow physicians began to see a rush of cases. Overlake’s emergency room held 30 beds. In early April, Heidelberger estimated that they had twice that number of COVID cases.
“The hardest part was that early on, we had no effective way of testing,” Heidelberger said. “You’d take a swab, then fill out a paper form in triplicate, call an office at the CDC and ask for permission, then ship it off.” Instead, Heidelberger and colleagues relied on travel histories and the telltale X-rays of lungs to guide them.
Then Heidelberger’s colleagues began getting sick. One of his fellow physicians was sent to the ICU and placed on a ventilator and a machine to oxygenate his blood.
His colleague recovered, but the incident haunted Heidelberger, who pulled his wife aside and laid out his financial documents. “I said to her, ‘Here are the passwords, here is the insurance, and the lawyer to call should something happen.’ She asked me, ‘Why are you telling me this?’ And I couldn’t tell her at first, but I was scared. I didn’t know what was going to happen.”
Since their peak in April, cases in Washington dropped then peaked again in the summer, before falling again. Heidelberger anticipates that kind of pattern will continue until a vaccine is with us.
“We make small advances in our understanding and treatment every day,” Heidelberger said. “It’s hard to appreciate in the moment. But when you look back to where we were a year ago, I think we’ve come a long way. We’ll take the future in the same way—day by day.”
Within hours of his first day of residency in the emergency room, Tyler Jackson met his first COVID-19 patient. A man in his early 60s reported a slight headache and fuzzy memory, signs that have come to be recognized as early indicators of the disease. Within hours, he showed signs of breathing difficulty. The first X-rays of his lungs showed significant inflammation confirmed by a CT scan.
“I was alarmed,” Jackson said. “There I was looking at the classic bilateral ‘broken glass’ infection I had been reading about. I almost couldn’t believe that so much damage could occur so quickly.”
This summer, Arizona was amid a sharp spike, with cases increasing by 700 percent from June to July. On the day Jackson began, the state reported 4,800 new cases—its highest in a single day. “I do feel like I was dropped right into the deep end,” he said. Over the next two months, Jackson estimated that he saw between seven and eight patients a day come through the ER.
“I’ve also seen more deaths in these first months than I ever would have anticipated,” Jackson added solemnly. “It’s been very humbling and exhausting.”
Yet Jackson said they have helped save many more, and credited his fellow residents and attending physicians for their response. “Everyone has rallied heroically. I’m proud to be a part of a team that has helped so many people through this.”
Jackson also cited his education for equipping him to meet this moment. “We spend a lot of time at the U learning about the art of medicine—the craft of caring for people—perhaps more than at other institutions. When you’re focused on exams, that can sometimes feel like a distraction. But it has made the difference for me here. No one could fully prepare for the mental and emotional toll of this pandemic, but I’m incredibly grateful for my training.”
As the summer spike abated, it offered room for Jackson to attend to his new life. His longtime girlfriend moved to be with him. “She has been incredibly supportive. This experience makes you think about your own life and future. I have to be careful to protect not just myself, but also those closest to me.”
Despite the pressure and risks, Jackson said that he wouldn’t change anything. “None of us will forget this time in our lives. It is making me a better doctor—and also a better person.”
John Wood once had to deliver a piece of bad news to a patient: He would not prescribe a medication that had been requested. His patient, a towering man in his late 30s, suddenly rushed forward as if to attack. Wood stood his ground as the patient stopped short of hitting him. A uniformed guard then stepped in to restrain the patient.
“That kind of thing doesn’t necessarily happen that often,” Wood said. “But you have to be ready for it in my line of work.”
Wood is the medical director for the Davis County Correctional Facility, a position he has held in addition to his family practice, from which he recently retired. Located in Farmington, halfway between Salt Lake City and Ogden, the jail averages a population of 800 inmates from the county, state, and federal correction systems.
Wood has provided jail and prison medicine for more than two decades. “Many people ask me, ‘Why do you do it? Is it safe?’” Wood said. “I find it incredibly rewarding. My experience is that most of the people who end up in jail aren’t intrinsically evil. There are certainly some very bad individuals. But the majority are people who made mistakes, are paying for them, and hopefully learning. It’s my role to keep them healthy while they’re inside.”
To do that, Wood must draw upon his medical expertise as well as a keen sense of intuition.
With the arrival of COVID-19, clusters of outbreaks have occurred in prisons across the country. The confined nature of correctional facilities has made them particularly susceptible to spreading the disease.
This summer, the neighboring Weber County jail, where Wood had worked prior years, experienced a severe outbreak affecting more than a hundred patients.
Fortunately, at the time of this writing (in October), the Davis facility had not yet faced a similar crisis. In fact, Wood had yet to see a case there.
Wood credits quick policies enacted by Sheriff Kelly Sparks for keeping the virus at bay. “In March, we quickly curtailed or eliminated in-person visits and reduced the number of inmates at the facility, by either transferring or seeking early release.”
If an outbreak does occur, Wood says he now feels better prepared. He developed a series of protocols to quickly isolate anyone identified with COVID from the community and—he hopes—contain the spread.
“Jail medicine is different medicine, but it should not be bad medicine,” Wood said. “Health care is a human right. I consider many of my patients—flawed as they might be—to be my friends and family. It’s my privilege to take care of them.”